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Research Project: The Environment and Children's Eating Behavior

Location: Children's Nutrition Research Center

2015 Annual Report


Objectives
Objective 1. Improve the validity and reliability of objective dietary assessment by combining the Sun e.button system which identifies a prioritized list of likely foods and amounts consumed and, at the end of the day (or the following morning), have children use ASA24-Kids to review, verify and correct food identity problems and portion size information from the Sun e.button images. Objective 2. Improve the validity and reliability of objective physical activity and sedentary behavior assessment (including both type and intensity) by combining the Sun e.button system with accelerometers, and enable children to review and correct estimates of type of activity/sedentary behavior from the Sun e.button using a simple correction recording system at the end of the day. Objective 3. Conduct formative research with parents of 8- to 10-year-old African American girls to identify beliefs, values, and practices related to diet, physical activity, sedentary behavior, and body weight. Objective 4. Develop and pilot test a text message-based intervention for parents to test the feasibility of the factors identified in Objective 3 at promoting a healthy home food and activity environment. Objective 5. Develop a model of parent-child interactions in the family eating environment among low-income families (based on direct observations), and determine what aspects of parent-child interactions foster excess calorie intake in children. 5A. Gather descriptive data based on direct observation of parent-child feeding interactions by examining differences in feeding practices as a function of child weight status, child gender, parent ethnicity, and parent weight status. 5B. Determine the effects of parent psychosocial characteristics (depression, marital stress, parenting stress) on feeding practices in low-income Head Start families. 5C. Determine the impact of feeding practices on the dietary intake of head Start children (food groups, energy intake) during the dinner meal. 5D. Model the impact of parent psychosocial characteristics on feeding practices which, in turn, will influence child dietary intake (food groups, energy intake), and child BMI.


Approach
Obesity is the most prevalent and severe nutrition related pediatric problem, especially among lower income and ethnic minority children. Most child obesity prevention interventions have not been effective. There has been disagreement about whether this lack of documented success has been due to a) inaccurate measurement for assessing what were really effective programs; b) not understanding what behaviors contribute to obesity; c) not understanding how parents influence those child behaviors; d) not effectively addressing cultural influences; or e) not using intervention procedures that effectively manipulated how parents related to their child. We plan to develop new technology that combines objective and self-report procedures to measure diet and physical activity that eliminate many of the known errors in self-report. Researchers will also identify the child behaviors contributing to obesity among 8- to 10-year-old African American girls; b) conduct formative qualitative research with parents of this age child; and c) develop and assess the feasibility of an innovative text message intervention for parents to change the home food and activity environments. Additionally, researchers propose to a) identify family factors that impact or moderate what parents do to influence their child’s diet; b) analyze how feeding styles interrelate with feeding practices to influence child’s diet; and c) develop and test sophisticated comprehensive statistical models of these variables. This research addresses several important knowledge gaps, and thereby establish a firm foundation for family-based obesity prevention interventions and evaluations in the future.


Progress Report
For Objectives 1 and 2 we recruited (n=20) 8-13 year old children and a parent; had them come to the Children's Nutrition Research Center; test the eButton; and interview them about using the eButton. We found height limitations with the use of the eButton and had to work vigorously on devising a comfortable yet safe lanyard for holding the eButton. Parents and children reported being positively predisposed to wearing the eButton for a full day at home and school. We next recruited (n=10) 8-13 year old children and a parent for the pilot study. These children wore the eButton but often turned it off and forgot to turn it back on. About 15% of the foods identified came from the child report at the end of the image processing the following day. A paper summarizing the formative research and the pilot study is being finalized among the authors. We have completed six participants in the primary study. We have also initiated analyses of the pilot study images to assess physical activity. For Objectives 4 and 5 African American parents of 8-10 year old girls (n=30) were recruited to advise and inform the research team about our intervention content and structure. Parents completed an online survey and a semi-structured telephone interview. Topics explored included technology ownership, access, and use; thoughts about receiving text messages promoting a healthy home food and activity environment to support child obesity prevention; and factors that influence diet and physical activity choices and obesity-related parenting practices (e.g., culture, family, friends). Suggestions for text message content were also discussed. Results indicated that parents were highly supportive of this approach and had access to the needed technology. The focus was expanded beyond diet and physical activity to include other behaviors in the home environment that influence child obesity risk, such as sedentary behavior, sugar-sweetened beverages, sleep, and stress. Using the parent information and the expanded focus as a guide, text messages were developed. An expert panel (n=10) is being convened to review the text messages. Data collection is currently underway. Permission was obtained to repeat 12 and 24 month milestones (Objective 4) with Hispanic parents. In Objective 6 we conducted analyses on observed feeding practices of low-income parents. These analyses included differences as a function of child weight status and gender and parent ethnicity. Analyses are underway to examine differences in feeding practices based on parental depression, marital stress, and parenting stress. Additional analyses are looking at differences in child intake by parental feeding styles. Any animal research conducted have received IACUC approval. Any human research studies conducted have received IRB approval.


Accomplishments
1. Formative research for using an eButton to assess children's diet. It is not known if children would be willing to wear a heavier (longer battery life) or lighter eButton for use in dietary recall use. The eButton is used to take several images over the course of the day and captures the food (type and quantity) consumed, however for a longer battery life, the unit would be heavier and larger than the lighter model. Researchers at the Children's Nutrition Research Center found that children were willing to wear the heavier eButton thereby enabling longer periods of observation. This was successfully accomplished due to a sophisticated lanyard with magnets being devised to enable most children to comfortably wear the eButton and no devastating concerns were identified that would preclude wearing the device all-day. The findings assist the researchers in using and testing the eButton with 8-13 year old children to assess their dietary intake.

2. Feeding practices of low-income mothers. How do they compare to current recommendations? Little is known about mother's compliance with current pediatric recommendations for feeding preschoolers. Researchers at the Children's Nutrition Research in Houston, TX evaluated recorded videotapes of low-income mother's observed feeding practices with their child and found that mothers spent a considerable amount of time encouraging eating in spite of their child's insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to children's feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Most of the mothers did not engage in responsive type feeding practices that are consistent with current pediatric recommendations for feeding young children. These results can be used to guide future research on low-income mothers' feeding practices and inform the development of interventions by identifying areas in need of change (i.e. teaching mothers to be sensitive to children's feelings of hunger and fullness).